Arrhythmia Section, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
J Cardiovasc Electrophysiol. 2021 May;32(5):1328-1336. doi: 10.1111/jce.15035. Epub 2021 Apr 16.
Stand-alone substrate ablation has become a standard ventricular tachycardia (VT) ablation strategy. We sought to evaluate the influence of baseline VT inducibility and activation mapping on ablation outcomes in patients with structural heart disease (SHD) undergoing VT ablation.
Single center, observational and retrospective study including consecutive patients with SHD and documented VT undergoing ablation. Baseline VT induction was attempted before ablation in all patients and VT activation mapping performed when possible. Ablation was guided by activation mapping for mappable VTs plus substrate ablation for all patients. Ablation outcomes and complications were evaluated.
One hundred and sixty patients were included and were classified in three groups according to baseline VT inducibility:group 1 (non inducible, n = 18), group 2 (1 VT morphology induced, n = 53), and group 3 (>1 VT morphology induced, n = 89). VT activation mapping was possible in 35%. After a median follow-up of 38.5 months, baseline inducibility of greater than 1 VT morphology was associated with a significant incidence of VT recurrence (42% for group 3 vs. 15.1% for group 2% and 5.6% for group 1, Log-rank p < .0001) and activation mapping with a lower rate of VT recurrence (24% vs. 36.3%, Log-rank p = .035). Baseline inducibility of greater than 1 VT morphology (hazards ratio [HR]: 12.05, 95% confidence interval [CI]: 1.60-90.79, p = .016) was an independent predictor of VT recurrence while left ventricular ejection fraction less than 30% (HR: 1.93, 95% CI: 1.13-3.25, p = .014) and advanced heart failure (HR: 4.69, 95% CI: 2.75-8.01, p < .0001) were predictors of mortality or heart transplantation. Complications occurred in 11.2% (5.6% hemodynamic decompensation).
Baseline VT inducibility and activation mapping may add significant prognostic information during VT ablation procedures.
孤立的基质消融已成为一种标准的室性心动过速（VT）消融策略。我们旨在评估结构性心脏病（SHD）患者行 VT 消融时基线 VT 可诱发性和激动标测对消融结果的影响。
本研究为单中心、观察性和回顾性研究，纳入了连续接受 SHD 且有记录的 VT 并接受消融治疗的患者。所有患者在消融前均尝试进行基线 VT 诱发性检查，当可能时进行 VT 激动标测。对于可激动标测的 VT 采用激动标测指导消融，对于所有患者均采用基质消融。评估消融结果和并发症。
共纳入 160 例患者，根据基线 VT 可诱发性分为三组：组 1（不可诱发性，n=18）、组 2（诱发性 1 种 VT 形态，n=53）和组 3（诱发性>1 种 VT 形态，n=89）。35%的患者可进行 VT 激动标测。中位随访 38.5 个月后，基线诱发性>1 种 VT 形态与 VT 复发的发生率显著相关（组 3 为 42%，组 2 为 15.1%，组 1 为 5.6%，Log-rank p<0.0001），而激动标测与 VT 复发率较低相关（24%比 36.3%，Log-rank p=0.035）。基线诱发性>1 种 VT 形态（风险比[HR]：12.05，95%置信区间[CI]：1.60-90.79，p=0.016）是 VT 复发的独立预测因素，而左心室射血分数<30%（HR：1.93，95%CI：1.13-3.25，p=0.014）和晚期心力衰竭（HR：4.69，95%CI：2.75-8.01，p<0.0001）是死亡或心脏移植的预测因素。并发症发生率为 11.2%（5.6%为血流动力学失代偿）。
基线 VT 可诱发性和激动标测可在 VT 消融过程中提供重要的预后信息。
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